This project seeks to develop a novel methodology for using proactive risk assessments on a single topic, conducted at multiple institutions, to develop a standardized process for use by all of the organizations. This project will adopt methods used by the nuclear energy industry. The project seeks to proactively assess the risks during transfers of pediatric patients from referring Emergency Departments (EDs) to six Chicago area hospitals (comprising the Pediatric Patient Safety Consortium) with inpatient pediatric services. The goals of the project are: Aim 1: Conducting six proactive risk assessments, using a Failure Modes Effect Analysis (FMEA), of the communication, documentation, and transfer processes of pediatric patients between referring EDs and each of the six hospitals with pediatric in-patient services that comprise the Pediatric Patient Safety Consortium in the Chicago area; Aim 1.1: Modeling potential failures related to known child specific risks in each FMEA; Aim 2: Condensing the results of the six FMEAs into a single set of specific communication, documentation, coordination, and systemic risk factors in emergency transfer of pediatric patients between referring EDs and hospitals with inpatient pediatric services; Aim 2.1: Examining the potential impacts of the fact that different organizations performed the analyses with different data, participants, scope, and analysis evaluation criteria by the application of a risk binning approach to the group of six FMEAs; Aim 3: Creating a standardized process and instruments to address communication, documentation, and coordination during transfers of pediatric patients between referring EDs and hospitals with pediatric in-patient services; and Aim 4: Field testing and refining the standardized process and instruments using a PDSA methodology in pilot studies at the Consortium institutions. Dissemination of the research findings is planned through the Chicago Patient Safety Forum, through peer-reviewed papers, and through presentations at national meetings. Pediatric patient safety is a critical public health issue. Approximately 70,000 U.S. hospitalized children experience an adverse event of which 60% are preventable. Little research has been done about patient safety in the ambulatory setting, specifically for children. This project focuses on pediatric patient safety in the ambulatory setting and offers a novel methodology that could be useful for the risk assessment of many other pediatric healthcare processes. [unreadable] [unreadable] [unreadable]